Shin splints are one of the most common running injuries, affecting 5%-35% of runners at any one time (Newman 2013). It is more formally known as medial tibial stress syndrome, and it is believed to be a stress reaction to the outer layer of bone (periosteum) as it connects to the muscle, tendon and fascia along the tibia. The pain is felt on the inside portion of the leg, slightly more than halfway down the leg.
The stress comes from the repetitive striking of the ground during running or running-like motions such as cutting, pivoting, lunging, and jumping common in sports. For a runner, a single mile is composed of approximately 1500 foot strikes. Considering that the lower leg must absorb 2-3 times the runner’s weight for every strike, one can see how a stress reaction can occur.
A calf muscle of particular interest regarding shin splints is the soleus. The soleus’s attachment to the tibia is pulled upon when the foot and ankle strike the ground while running. Small fibers called Sharpey’s fibers anchor the muscle to the bone. Stress on this area can be adaptive, leading to positive changes which allow the runner to have greater running capacity, or maladaptive changes which lead to pain, medial tibial stress syndrome, and if not addressed, eventual stress fractures.
Prevention consists of identifying the intrinsic and extrinsic risk factors and making changes whenever possible. See the table below (Couture 2002):
If you’re considering running, a preparticipation functional assessment can help you determine if you’re at risk. How we move and function can be a predictor of whether or not shin splints develop. For example, Wilkelmann et. al, found that navicular drop, ankle plantar flexion, and hip external rotation were biomechanical metrics that could be used to determine the likelihood of shin splints. An increased BMI was also a predictive factor. Clinical palpation tests of the medial leg producing pain or showing signs of edema or both were linked to a significantly increased chance of the future development of shin splints (Newman 2012). These risk factors can be assessed in our office here at the Center for Musculoskeletal Function.
Couture, Christopher J., and Kristine A. Karlson. “Tibial Stress Injuries.” The Physician and Sportsmedicine, vol. 30, no. 6, 2002, pp. 29-36.
Craig, Debbie I. “Medial Tibial Stress Syndrome: Evidence-Based Prevention.” Journal of Athletic Training, vol. 43, no. 3, 2008, pp. 316-318.
Fick, Daniel S., et al. “Relieving Painful ‘Shin Splints’.” The Physician and Sportsmedicine, vol. 20, no. 12, 1992, pp. 105-113.
Mayo, M., et al. “Structured neuromuscular warm-up for injury prevention in young elite football players.” Revista Española de Cirugía Ortopédica y Traumatología (English Edition), vol. 58, no. 6, 2014, pp. 336-342.
Newman, Phil, et al. “Two simple clinical tests for predicting onset of medial tibial stress syndrome: shin palpation test and shin oedema test.” British Journal of Sports Medicine, vol. 46, no. 12, 2012, pp. 861-864.
Newman, Phillip, et al. “Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis.” Open Access Journal of Sports Medicine, 2013, p. 229.
Winkelmann, Zachary K., et al. “Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review.” Journal of Athletic Training, vol. 51, no. 12, 2016, pp. 1049-1052.